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Inside Dental Hygiene
August 2021
Volume 0, Issue 0

Relief from Rheumatoid Arthritis

Oral Care is Key

Barbara L. McClatchie, DDS

Reducing sources of oral inflammation is a cornerstone of my patient care. We believe in providing patients all the diagnostics available to make sure their oral health is optimal. The link between oral and systemic health is well documented, and it is important to obtain a full picture of what is going on in the mouth. Using salivary diagnostic testing and incorporating inflammatory blood panels are just a part of our patient care protocol.

One recent patient had been diagnosed with rheumatoid arthritis (RA) and his health was steadily declining. His joints were sore and swollen; he was losing weight and was confined to his bed 20 hours a day. Traditional medical approaches to RA were not providing relief. Finally, biofeedback sessions indicated he had severe oral inflammation. He was immediately referred to our practice.

Dental hygienist Rebecca Owens Boyer, RDH, explained what was provided during his initial visit, which included: a full review of his medical history, taking his blood pressure, a CBCT scan, an oral saliva test to identify pathogenic bacteria, a full series of dental x-rays, full periodontal charting-including clinical attachment length and bleeding sites-and intraoral photos of the dentition. The oral saliva test revealed high levels of high-risk periodontal pathogens that contribute to cardiovascular disease, Alzheimer's, cancer, joint inflammation, and autoimmune disease.

Radiographic results clearly showed bone loss and five periapical radiolucencies, but no radiographic calculus. The CBCT results showed several areas of concern, including five hypodensities at root apices as well as carotid calcification and a narrow airway. His gingival tissue was generally pink and not showing inflammation, likely due to the anti-inflammatory for RA that he was taking. When Boyer began periodontal charting, it was clear the patient's mouth was full of infection. There were 168 sites of bleeding and 68 sites of suppuration-despite the visual appearance.

An inflammatory blood panel was drawn prior to treatment to capture the patient's starting inflammation markers, which revealed extremely high levels of severe inflammation. The High Sensitivity C-Reactive Protein (hs-CRP) level was 35; normal is under 1. At this point, we recommended the patient have a CIMT (Carotid Intima Media Thickness) scan, which showed he had soft plaque in the lining of his carotid arteries, putting him at high risk for a cardiovascular event due to his systemic inflammation.

The patient spent 4.5 hours in the chair for four quadrants of periodontal therapy to break up the high-risk bacteria. We used five-tip ultrasonic therapy and performed subgingival biofilm debridement. Based on his oral pathogens, he was prescribed a 10-day course of recommended systemic antibiotics and a dental care probiotic to help replenish healthy bacteria. For my patients, I dispense a probiotic containing a patented blend of three strains of naturally occurring oral bacteria: Streptococcus oralis KJ3®, Streptococcus uberis KJ2®, and Streptococcus rattus JH145®. As the positive bacteria repopulates and colonizes on tooth and gum surfaces, it crowds out the pathogenic bacteria.

This patient was also advised to use oral care rinses and gels to help heal from the periodontal therapy and use prescription trays to deliver 1.7% hydrogen peroxide gel deep into the sulcus to fight the anaerobic pathogens. Two weeks after his initial therapy, the patient reported that his hand pain was gone, and his knees were improving. A second blood panel was completed. His hs-CRP level had dropped to 26.6. Ten weeks after periodontal therapy, a follow-up oral saliva test was completed. The periodontal pathogens decreased by 30%. He also reported he had more energy. Twelve weeks post-periodontal therapy he had a 3-month periodontal maintenance appointment where another periodontal charting was performed. Bleeding points decreased to just 3 with zero suppuration.  Knowing his high risk for a cardiovascular event, another round of antibiotics was prescribed to protect him systematically from the bacteremia. He also appeared much healthier.

Over the course of his treatment, the patient underwent two of the five endodontic treatments as well as having two extractions with bone grafting. A third blood draw was completed, and his hs-CRP result was 1.5. A third oral saliva test was conducted and revealed a 60% reduction of dangerous oral pathogens.

The patient's overall health is improving congruently with his oral health. His rheumatologist has reduced the number and dosage of his RA medications. He is grateful for his recovery and impressed by the difference that thorough dental care made in his overall health.

About the Author

Barabara L. McClatchie, DDS
The Heart Attack and Stroke Prevention Center of Central Ohio
Columbus, Ohio

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